The role of interventional radiology in the palliative care of patients with cancer

Over the past four decades, a variety of invasive diagnostic and therapeutic procedures have been developed by radiologists. The term ‘Interventional Radiology’ most appropriately refers to therapeutic procedures performed under imaging guidance⁽¹⁾. The emergence of this specialty has been made possible by enormous technological advances in relation to catheter and instrument design and manufacture, imaging systems, and radiological expertise. Interventional radiological procedures have virtually replaced several more invasive and hazardous surgical alternatives. Other interventional techniques offer completely new therapeutic options. Some diagnostic radiological procedures are frequently followed by therapeutic manoeuvres. For example, percutaneous antegrade pyelography, performed to delineate the site and nature of renal obstruction, is usually followed immediately by the placement of a nephrostomy drainage catheter⁽²⁾. Purely diagnostic procedures, such as percutaneous biopsy, will not be discussed in any detail, as they are largely inappropriate for the patient with a known neoplastic process receiving palliative care.

All interventional procedures carry some risk, which is related to the underlying condition, the nature of the procedure, and the experience of the radiologist. Therefore, it is important in patients with advanced malignant disease receiving palliative care to contemplate only those procedures that will alleviate symptoms, and in which the potential benefits outweigh the risks⁽³⁾.

Interventional radiology can make a significant contribution to the palliation of patients with irresectable malignant tumours, as many of the procedures can relieve symptoms without the need for general anaesthesia, a prolonged stay in hospital, or the discomfort associated with recovery from a surgical operation. The vast majority of procedures are performed using local anaesthesia and mild sedation. The emphasis in this chapter is on the indications, contraindications, and likely outcomes, rather than on detailed technical descriptions.